Fragmented wide QRS on a 12-lead ECG

a sign of myocardial scar and poor prognosis.

Mithilesh Das, Hussam Suradi, Waddah Maskoun, Mark A. Michael, Changyu Shen, Jonathan Peng, Gopi Dandamudi, J. Mahenthiran

Research output: Contribution to journalArticle

211 Citations (Scopus)

Abstract

BACKGROUND: Fragmented QRS (duration <120 ms) on a 12-lead ECG represents myocardial scar in patients with coronary artery disease. However, the significance of fragmented QRS has not been defined in the presence of a wide QRS (wQRS; duration >or=120 ms). We postulate that fragmented wQRS (f-wQRS) due to bundle branch block, premature ventricular complexes, or paced rhythms (f-pQRS) signify myocardial scar and higher mortality. METHODS AND RESULTS: Patients who underwent cardiac evaluation with nuclear stress imaging or cardiac catheterization and had wQRS (bundle branch block, premature ventricular complex, or pQRS) were studied. f-wQRS was defined by the presence of >2 notches on the R wave or the S wave and had to be present in >or=2 contiguous inferior (II, III, aVF), lateral (I, aVL, V(6)) or anterior (V(1) to V(5)) leads. ECG analyses of 879 patients (age, 66.7+/-11.4 years; male, 97%; mean follow-up, 29+/-18 months) with bundle branch block (n=310), premature ventricular complex (n=301), and pQRS (n=268) revealed f-wQRS in 415 (47.2%) patients. Myocardial scar was present in 440 (50%) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of f-wQRS for myocardial scar were 86.8%, 92.5%, 92.0%, and 87.5%, respectively. The sensitivity and specificity for diagnosing myocardial scar were 88.6% and 94.4%, 81.4% and 88.4%, and 89.8% and 95.7% for f-bundle branch block, f-premature ventricular complex, and f-pQRS, respectively. f-wQRS was associated with mortality after adjusting for age, ejection fraction, and diabetes (P=0.017). CONCLUSIONS: f-wQRS on a standard 12-lead ECG is a moderately sensitive and highly specific sign for myocardial scar in patients with known or suspected coronary artery disease. f-wQRS is also an independent predictor of mortality.

Original languageEnglish
Pages (from-to)258-268
Number of pages11
JournalCirculation: Arrhythmia and Electrophysiology
Volume1
Issue number4
DOIs
StatePublished - Oct 2008

Fingerprint

Ventricular Premature Complexes
Bundle-Branch Block
Cicatrix
Electrocardiography
Mortality
Sensitivity and Specificity
Cardiac Catheterization
Coronary Artery Disease
Lead

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Fragmented wide QRS on a 12-lead ECG : a sign of myocardial scar and poor prognosis. / Das, Mithilesh; Suradi, Hussam; Maskoun, Waddah; Michael, Mark A.; Shen, Changyu; Peng, Jonathan; Dandamudi, Gopi; Mahenthiran, J.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 1, No. 4, 10.2008, p. 258-268.

Research output: Contribution to journalArticle

Das, M, Suradi, H, Maskoun, W, Michael, MA, Shen, C, Peng, J, Dandamudi, G & Mahenthiran, J 2008, 'Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis.', Circulation: Arrhythmia and Electrophysiology, vol. 1, no. 4, pp. 258-268. https://doi.org/10.1161/CIRCEP.107.763284
Das, Mithilesh ; Suradi, Hussam ; Maskoun, Waddah ; Michael, Mark A. ; Shen, Changyu ; Peng, Jonathan ; Dandamudi, Gopi ; Mahenthiran, J. / Fragmented wide QRS on a 12-lead ECG : a sign of myocardial scar and poor prognosis. In: Circulation: Arrhythmia and Electrophysiology. 2008 ; Vol. 1, No. 4. pp. 258-268.
@article{f72defb97a28488b999432345e28c35b,
title = "Fragmented wide QRS on a 12-lead ECG: a sign of myocardial scar and poor prognosis.",
abstract = "BACKGROUND: Fragmented QRS (duration <120 ms) on a 12-lead ECG represents myocardial scar in patients with coronary artery disease. However, the significance of fragmented QRS has not been defined in the presence of a wide QRS (wQRS; duration >or=120 ms). We postulate that fragmented wQRS (f-wQRS) due to bundle branch block, premature ventricular complexes, or paced rhythms (f-pQRS) signify myocardial scar and higher mortality. METHODS AND RESULTS: Patients who underwent cardiac evaluation with nuclear stress imaging or cardiac catheterization and had wQRS (bundle branch block, premature ventricular complex, or pQRS) were studied. f-wQRS was defined by the presence of >2 notches on the R wave or the S wave and had to be present in >or=2 contiguous inferior (II, III, aVF), lateral (I, aVL, V(6)) or anterior (V(1) to V(5)) leads. ECG analyses of 879 patients (age, 66.7+/-11.4 years; male, 97{\%}; mean follow-up, 29+/-18 months) with bundle branch block (n=310), premature ventricular complex (n=301), and pQRS (n=268) revealed f-wQRS in 415 (47.2{\%}) patients. Myocardial scar was present in 440 (50{\%}) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of f-wQRS for myocardial scar were 86.8{\%}, 92.5{\%}, 92.0{\%}, and 87.5{\%}, respectively. The sensitivity and specificity for diagnosing myocardial scar were 88.6{\%} and 94.4{\%}, 81.4{\%} and 88.4{\%}, and 89.8{\%} and 95.7{\%} for f-bundle branch block, f-premature ventricular complex, and f-pQRS, respectively. f-wQRS was associated with mortality after adjusting for age, ejection fraction, and diabetes (P=0.017). CONCLUSIONS: f-wQRS on a standard 12-lead ECG is a moderately sensitive and highly specific sign for myocardial scar in patients with known or suspected coronary artery disease. f-wQRS is also an independent predictor of mortality.",
author = "Mithilesh Das and Hussam Suradi and Waddah Maskoun and Michael, {Mark A.} and Changyu Shen and Jonathan Peng and Gopi Dandamudi and J. Mahenthiran",
year = "2008",
month = "10",
doi = "10.1161/CIRCEP.107.763284",
language = "English",
volume = "1",
pages = "258--268",
journal = "Circulation: Arrhythmia and Electrophysiology",
issn = "1941-3149",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Fragmented wide QRS on a 12-lead ECG

T2 - a sign of myocardial scar and poor prognosis.

AU - Das, Mithilesh

AU - Suradi, Hussam

AU - Maskoun, Waddah

AU - Michael, Mark A.

AU - Shen, Changyu

AU - Peng, Jonathan

AU - Dandamudi, Gopi

AU - Mahenthiran, J.

PY - 2008/10

Y1 - 2008/10

N2 - BACKGROUND: Fragmented QRS (duration <120 ms) on a 12-lead ECG represents myocardial scar in patients with coronary artery disease. However, the significance of fragmented QRS has not been defined in the presence of a wide QRS (wQRS; duration >or=120 ms). We postulate that fragmented wQRS (f-wQRS) due to bundle branch block, premature ventricular complexes, or paced rhythms (f-pQRS) signify myocardial scar and higher mortality. METHODS AND RESULTS: Patients who underwent cardiac evaluation with nuclear stress imaging or cardiac catheterization and had wQRS (bundle branch block, premature ventricular complex, or pQRS) were studied. f-wQRS was defined by the presence of >2 notches on the R wave or the S wave and had to be present in >or=2 contiguous inferior (II, III, aVF), lateral (I, aVL, V(6)) or anterior (V(1) to V(5)) leads. ECG analyses of 879 patients (age, 66.7+/-11.4 years; male, 97%; mean follow-up, 29+/-18 months) with bundle branch block (n=310), premature ventricular complex (n=301), and pQRS (n=268) revealed f-wQRS in 415 (47.2%) patients. Myocardial scar was present in 440 (50%) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of f-wQRS for myocardial scar were 86.8%, 92.5%, 92.0%, and 87.5%, respectively. The sensitivity and specificity for diagnosing myocardial scar were 88.6% and 94.4%, 81.4% and 88.4%, and 89.8% and 95.7% for f-bundle branch block, f-premature ventricular complex, and f-pQRS, respectively. f-wQRS was associated with mortality after adjusting for age, ejection fraction, and diabetes (P=0.017). CONCLUSIONS: f-wQRS on a standard 12-lead ECG is a moderately sensitive and highly specific sign for myocardial scar in patients with known or suspected coronary artery disease. f-wQRS is also an independent predictor of mortality.

AB - BACKGROUND: Fragmented QRS (duration <120 ms) on a 12-lead ECG represents myocardial scar in patients with coronary artery disease. However, the significance of fragmented QRS has not been defined in the presence of a wide QRS (wQRS; duration >or=120 ms). We postulate that fragmented wQRS (f-wQRS) due to bundle branch block, premature ventricular complexes, or paced rhythms (f-pQRS) signify myocardial scar and higher mortality. METHODS AND RESULTS: Patients who underwent cardiac evaluation with nuclear stress imaging or cardiac catheterization and had wQRS (bundle branch block, premature ventricular complex, or pQRS) were studied. f-wQRS was defined by the presence of >2 notches on the R wave or the S wave and had to be present in >or=2 contiguous inferior (II, III, aVF), lateral (I, aVL, V(6)) or anterior (V(1) to V(5)) leads. ECG analyses of 879 patients (age, 66.7+/-11.4 years; male, 97%; mean follow-up, 29+/-18 months) with bundle branch block (n=310), premature ventricular complex (n=301), and pQRS (n=268) revealed f-wQRS in 415 (47.2%) patients. Myocardial scar was present in 440 (50%) patients. The sensitivity, specificity, positive predictive value, and negative predictive value of f-wQRS for myocardial scar were 86.8%, 92.5%, 92.0%, and 87.5%, respectively. The sensitivity and specificity for diagnosing myocardial scar were 88.6% and 94.4%, 81.4% and 88.4%, and 89.8% and 95.7% for f-bundle branch block, f-premature ventricular complex, and f-pQRS, respectively. f-wQRS was associated with mortality after adjusting for age, ejection fraction, and diabetes (P=0.017). CONCLUSIONS: f-wQRS on a standard 12-lead ECG is a moderately sensitive and highly specific sign for myocardial scar in patients with known or suspected coronary artery disease. f-wQRS is also an independent predictor of mortality.

UR - http://www.scopus.com/inward/record.url?scp=60349086404&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=60349086404&partnerID=8YFLogxK

U2 - 10.1161/CIRCEP.107.763284

DO - 10.1161/CIRCEP.107.763284

M3 - Article

VL - 1

SP - 258

EP - 268

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

SN - 1941-3149

IS - 4

ER -